Federal Register / Vol. 89, No. 247 / Thursday, December 26, 2024 / Notices 105049 

1See the United States Census Bureau: Historical 

Population Density Data (1910–2020) available at: 

https://www.census.gov/data/tables/time-series/ 

dec/density-data-text.html. 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–5051–N2] 

Medicare Program; Rural Community 

Hospital Disemonstration Program: 

Solicitation of Additional Participants 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), Department 

of Health and Human Services (HHS). 

ACTION: Notice. 

SUMMARY: This notice announces a 

solicitation for up to 10 additional 

eligible hospitals to participate in the 

Rural Community Hospital 

Demonstration program, to run through 

June 30, 2028. 

DATES: To be assured consideration, 

applications must be received at the 

address provided below by 11:59 p.m. 

Eastern Standard Time (E.S.T.) on 

March 1, 2025. 

ADDRESSES: Please email completed 

applications to the following email 

address: RCHDemo@cms.hhs.gov. 

FOR FURTHER INFORMATION CONTACT: 

Alexis Lilly at 410–786–3501 or by 

email at alexis.lilly@cms.hhs.gov. 

SUPPLEMENTARY INFORMATION: 

I. Background 

Section 410A(a) of the Medicare 

Prescription Drug, Improvement and 

Modernization Act of 2003 (Public Law 

(Pub. L. 108–173) required the Secretary 

to establish a demonstration program to 

test the feasibility and advisability of 

establishing cost-based reimbursement 

for ‘‘rural community hospitals’’ to 

furnish covered inpatient hospital 

services to Medicare beneficiaries. The 

demonstration pays rural community 

hospitals for such services under a costbased methodology for Medicare 

payment purposes for covered inpatient 

hospital services furnished to Medicare 

beneficiaries. A rural community 

hospital, as defined in section 

410A(f)(1) of Public Law 108–173, is a 

hospital that— 

• Is located in a rural area (as defined 

in section 1886(d)(2)(D) of the Social 

Security Act (the Act)) or is treated as 

being so located pursuant to section 

1886(d)(8)(E) of the Act; 

• Has fewer than 51 acute care 

inpatient beds (excluding beds in a 

distinct psychiatric or rehabilitation 

unit of the hospital) as reported in its 

most recent cost report; 

• Provides 24-hour emergency care 

services; and 

• Is not designated or eligible for 

designation as a critical access hospital 

under section 1820 of the Act. 

The demonstration is designed to test 

the feasibility and advisability of 

reasonable cost reimbursement for 

inpatient services to small rural 

hospitals. The demonstration is aimed 

at increasing the capability of the 

selected rural hospitals to meet the 

needs of their service areas. 

We began the demonstration in 2004 

for the initial 5-year period mandated 

under section 410A of Public Law 108– 

173. The demonstration has been 

extended three times, each time for an 

additional 5-year period—first, by 

sections 3123 and 10313 of the 

Affordable Care Act (Pub. L. 111–148); 

then by section 15003 of the 21st 

Century Cures Act (Pub. L. 114–255), 

and again by section 128 of the 

Consolidated Appropriations Act of 

2021 (Pub. L. 116–260). The current 5- 

year period of participation, mandated 

by Public Law 116–260, ends June 30, 

2028. 

As part of our broader rural strategy 

initiative and recognizing the health 

care challenges facing rural 

communities, we are conducting a new 

solicitation to select 10 additional 

qualifying hospitals to participate in the 

Rural Community Hospital 

Demonstration approving such hospitals 

on a rolling basis beginning May 1, 2025 

through June 30, 2028. Please note that, 

although previous agreements ran for 5- 

year periods, agreements under this 

provision will run only until June 30, 

2028. Given the upcoming statutory 

termination of the model, we are 

aligning performance dates for the 

selected hospitals with the last 

performance day for the last currently 

participating hospital in this 

performance cycle. 

Section 410A(a)(4) of Public Law 108– 

173 specified that the Secretary was to 

select for participation from among the 

applicants in rural areas of States that 

the Secretary identified as having low 

population densities. Therefore, we will 

only accept applications to this 

solicitation from hospitals in the 20 

least densely populated States, 

according to data for 2020 from the U.S. 

Census Bureau. These States are: 

Alaska, Arizona, Arkansas, Colorado, 

Idaho, Iowa, Kansas, Maine, 

Mississippi, Montana, Nebraska, 

Nevada, New Mexico, North Dakota, 

Oklahoma, Oregon, South Dakota, Utah, 

Vermont, and Wyoming. We will not 

accept applications from hospitals 

located in other States or in the US 

territories.1 The statute states that no 

more than 30 rural community hospitals 

can participate. Twenty hospitals are 

currently participating in the 

demonstration program as of November 

1, 2024; therefore, up to 10 additional 

hospitals may be selected to be able to 

begin participation in the demonstration 

in 2025. 

II. Provisions of the Notice 

This notice announces the solicitation 

for up to 10 additional hospitals to 

participate in the Rural Community 

Hospital Demonstration Program. 

Hospitals that enter the demonstration 

under this solicitation will be able to 

participate from May 1, 2025 through 

June 30, 2028 

A. Demonstration Payment Methodology 

Hospitals selected for the 

demonstration will be paid the 

reasonable costs of providing covered 

inpatient hospital services, with the 

exclusion of services furnished in a 

psychiatric or rehabilitation unit that is 

a distinct part of the hospital, using the 

following rules. For discharges 

occurring— 

• In the first cost report period upon 

the hospital’s participation in the 

demonstration, reasonable costs for 

covered inpatient services; and 

• During the second or subsequent 

cost reporting period, the lesser of their 

reasonable costs or a target amount. The 

target amount in the second cost 

reporting period is defined as the 

reasonable costs of providing covered 

inpatient hospital services in the first 

cost reporting period, increased by the 

inpatient prospective payment system 

update factor (as defined in section 

1886(b)(3)(B) of the Act) for that 

particular cost reporting period. The 

target amount in subsequent cost 

reporting periods is defined as the 

preceding cost reporting period’s target 

amount increased by the hospital 

inpatient prospective payment system 

(IPPS) update factor for that particular 

cost reporting period. 

Covered inpatient hospital services 

means inpatient hospital services (as 

defined in section 1861(b) of the Act) 

and includes extended care services 

furnished under an agreement under 

section 1883 of the Act (also known as 

‘‘swing beds’’). 

Section 410A of Public Law 108–173 

requires that, in conducting the 

demonstration program under this 

section, the Secretary shall ensure that 

the aggregate payments made by the 


ddrumheller on DSK120RN23PROD with NOTICES1
105050 Federal Register / Vol. 89, No. 247 / Thursday, December 26, 2024 / Notices 

Secretary do not exceed the amount 

which the Secretary would have paid if 

the demonstration program under this 

section was not implemented. To 

achieve budget neutrality for this 

demonstration program in fiscal years 

(FYs) since 2004, we have adjusted the 

national IPPS rates by an amount 

sufficient to offset the added costs of 

this demonstration program. We will 

present an estimate of the amount to 

offset additional costs due to the 

demonstration program in FY 2026, 

including the costs of additional rural 

community hospitals, in the FY 2026 

IPPS/long-term care hospital (LTCH) 

PPS proposed rule. 

B. Participation in the Demonstration 

To participate in the demonstration, a 

hospital must be located in one of the 

identified States with low-population 

density and meet the criteria for a rural 

community hospital. Eligible hospitals 

that desire to participate in the 

demonstration must properly submit a 

timely application. Only applications 

that are received by the deadline 

specified in the DATES section of this 

notice will be considered ‘‘timely’’ and 

reviewed by the technical panel. 

Information about the demonstration 

and details on how to apply can be 

found on the CMS website: https://

www.cms.gov/priorities/innovation/ 

innovation-models/rural-communityhospital. 

III. Collection of Information 

Requirements 

The information collection 

requirements contained in this notice 

are subject to the Paperwork Reduction 

Act of 1995. As discussed in section 

II.B. of this notice, a hospital must 

submit the required information listed 

on the cover sheet of the CMS Medicare 

Waiver Demonstration Application to 

receive consideration by the technical 

review panel. The burden associated is 

the time and effort necessary to 

complete the Medicare Waiver 

Application and submit the information 

to CMS and is associated with OMB 

control number 0938–0880. 

The Administrator of the Centers for 

Medicare & Medicaid Services (CMS), 

Chiquita Brooks-LaSure, having 

reviewed and approved this document, 

authorizes Chyana Woodyard, who is 

the Federal Register Liaison, to 

electronically sign this document for 

purposes of publication in the Federal 

Register. 

Chyana Woodyard, 

Federal Register Liaison, Centers for Medicare 

& Medicaid Services. 

[FR Doc. 2024–30719 Filed 12–20–24; 4:15 pm] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Proposed Information Collection 

Activity; Sexual Risk Avoidance 

Education (SRAE) National Evaluation 

Overarching Generic (New Collection) 

AGENCY: Office of Planning, Research, 

and Evaluation, Administration for 

Children and Families, U.S. Department 

of Health and Human Services. 

ACTION: Request for public comments. 

SUMMARY: The Administration for 

Children and Families’ (ACF) Office of 

Planning, Research, and Evaluation 

(OPRE) requests Office of Management 

and Budget (OMB) approval for an 

overarching generic clearance to collect 

data from programs delivered by Sexual 

Risk Avoidance Education (SRAE) grant 

recipients on behalf of the SRAE 

National Evaluation. The generic 

mechanism will allow ACF to rapidly 

respond to research and evaluation 

opportunities that would not otherwise 

be feasible under the timelines 

associated with the Paperwork 

Reduction Act of 1995. The 

opportunities may relate to innovative 

implementation strategies and program 

components in use by SRAE grant 

recipients as they arise, and in 

particular, for youth subpopulations 

served by grant recipients. The purpose 

of the data collections submitted under 

the generic will be to inform ACF 

programming by building evidence 

about what innovations work to 

improve programming and outcomes 

across the SRAE grant recipients and the 

youth they serve. 

DATES: Comments due February 24, 

2025. In compliance with the 

requirements of the Paperwork 

Reduction Act of 1995, ACF is soliciting 

public comment on the specific aspects 

of the information collection described 

above. 

ADDRESSES: You can obtain copies of the 

proposed collection of information and 

submit comments by emailing 

OPREinfocollection@acf.hhs.gov. 

Identify all requests by the title of the 

information collection. 

SUPPLEMENTARY INFORMATION: 

Description: Under the proposed 

umbrella generic, OPRE intends to 

conduct research and evaluation of 

innovative implementation strategies 

and program components used by SRAE 

grant recipients and in particular, for 

youth subpopulations served by grant 

recipients. There is not an extensive 

evidence base on SRAE programming to 

inform SRAE grant recipients’ 

implementation and program 

improvement efforts. To add to this 

limited body of evidence and to support 

ACF’s administration of the SRAE grant 

program, the SRAE National Evaluation 

includes data collection to identify 

strategies and components that have the 

potential to improve the delivery and/or 

quality of SRAE programming and to 

understand better how to meet the 

needs of the range of youth served by 

the programs. As the evaluation team 

identifies strategies that are ready for 

evaluation, the work will need to begin 

quickly so that the learnings can be 

disseminated back to SRAE grant 

recipients within the period of 

performance. Due to the need for this 

rapid decision making, OPRE is seeking 

approval for a generic clearance to 

conduct this research. Potential data 

collection efforts include conducting 

interviews with SRAE program staff, 

including front-line facilitators working 

directly with youth; staff from partner 

organizations that work with SRAE 

programs; brief exit tickets following 

individual program sessions, focus 

groups, and surveys of youth 

participating in SRAE programs; session 

logs completed by program facilitators 

after individual program sessions; and 

analysis plan and report templates that 

grant recipients can use to disseminate 

their own evaluation findings. 

Under this generic clearance, 

information is meant to inform ACF 

activities and may be incorporated into 

documents or presentations that are 

made public such as through conference 

presentations, websites, or social media. 

The following are some examples of 

ways in which we may share 

information resulting from these data 

collections: technical assistance (TA) 

plans, webinars, presentations, 

infographics, issue briefs/reports, 

evaluation specific reports, or other 

documents relevant to the field, such as 

federal leadership and staff, grant 

recipients, local implementing agencies, 

researchers, and/or training/TA 

providers. In sharing findings, we will 

describe the study methods and 

limitations regarding generalizability 

and as a basis for policy. 

Following standard OMB 

requirements, OPRE will submit an 

individual request for each specific data 


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